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Ukert B, Huang Y, Sennett B, Delgado K. State-level variation in opioid prescribing after knee arthroscopy among the opioid-naïve in the USA: 2015-2019. BMJ Open 2020; 10:e035126. [PMID: 32819935 PMCID: PMC7440827 DOI: 10.1136/bmjopen-2019-035126] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE It has been established that most patients prescribed opioids after minor surgery have tablets left over, better understanding the variation in opioid prescribing and variation in dosage of the prescription could guide efforts to reduce prescribing. This study describes the state-level variation in opioid prescribing after a knee arthroscopy among opioid-naïve patients. DESIGN Retrospective cohort study. SETTING Commercial insurance claims data. PARTICIPANTS 98 623 individual across the USA with commercial insurance who were opioid-naïve and had a knee arthroscopy between 2015 and 2019. EXPOSURE Patients who filled an opioid prescription within 3 days of a knee arthroscopy. OUTCOME MEASURES Opioid prescriptions were measured as a pharmacy claim for filling an opioid within 3 days of a knee arthroscopy. We measured the patient and state-level opioid prescribing rate, tablet count, morphine milligram equivalent dose per prescription and risk-adjusted predicted opioid quantity. RESULTS Overall, 72% of patients filled an opioid prescription with a median tablet count of 40 and median morphine milligram equivalent of 250. Patients with an invasive procedure (27.9% vs 22.4%; p<0.001), higher education level (p<0.001) and fewer comorbidities (0.9 vs 1.2, p<0.001) had higher rates of opioid prescribing. The prescribing rate in the highest state, Nebraska (85%), was double the prescribing rate in the lowest state, South Dakota (40%). Comparing the casemix adjusted expected prescribing rate to the observed prescribing rate displayed that 18 states had observed prescribing rates that were higher than their expected prescribing rates. CONCLUSION Wide variation in the likelihood of receiving a prescription, depending on state of residence, was observed. The dosages prescribed were high and have been associated with transition to long-term use. These findings suggest that there is substantial opportunity for the development of guidelines to reduce variability in opioid prescribing for this common ambulatory procedure.
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Affiliation(s)
- Benjamin Ukert
- Department of Health Policy and Management, School of Public Health, Texas A&M University System, College Station, Texas, USA
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennylvania, Philadelphia, Pennsylvania, USA
| | - Yanlan Huang
- Leonard Davis Institute of Health Economics, University of Pennylvania, Philadelphia, Pennsylvania, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Brian Sennett
- Division of Sports Medicine, Department of Orthopedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kit Delgado
- Penn Injury Science Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennylvania, Philadelphia, Pennsylvania, USA
- Center for Emergency Care Policy and Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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102
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Moutzouros V, Jildeh TR, Khalil LS, Schwartz K, Hasan L, Matar RN, Okoroha KR. A Multimodal Protocol to Diminish Pain Following Common Orthopedic Sports Procedures: Can We Eliminate Postoperative Opioids? Arthroscopy 2020; 36:2249-2257. [PMID: 32353620 DOI: 10.1016/j.arthro.2020.04.018] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether postsurgical pain, measured by the visual analog scale (VAS), following common orthopaedic sports procedures could be managed effectively with a nonopioid multimodal analgesic protocol. METHODS This prospective study evaluated a custom multimodal nonopioid pain protocol in patients undergoing common orthopaedic sports procedures by a single fellowship-trained orthopaedic sports surgeon from May 2018 to December 2018. Procedures included anterior cruciate ligament reconstruction, rotator cuff repair, arthroscopic partial meniscectomy, and labrum repair. The nonopioid pain protocol consisted of preoperative analgesics, intraoperative local infiltration analgesia, and a postoperative pain regimen. Patient pain was immediately reported after surgery and 1 week postoperatively using the VAS, whereas rescue opioids (oxycodone 5 mg) used were recorded using a prescription opioid journal. Statistical analysis of patient VAS scores, demographic correlations, and comparison between opioid rescue users versus nonusers was performed. RESULTS A total of 141 patients were included. One week following surgery, patients reported a mean VAS level of 3.2 ± 2.3 and required on average 2.6 ± 3.6 breakthrough oxycodone pills (8.6 ± 12.0 morphine equivalents). Forty-five percent of patients did not require any breakthrough prescription opioids and reported satisfaction with pain management. Patients who required opioids were more likely to have a history of anxiety/depression (44.2% vs 23.8%, P = .012) and reported greater pain scores as compared with nonusers (3.94 ± 2.5 vs 2.41 ± 1.75, P = .016). The most common side effect of the pain protocol was feeling drowsy (23.5%). All patients were satisfied with their pain management postoperatively. CONCLUSIONS A multimodal, nonopioid pain protocol was found to be effective in managing postoperative pain following common orthopedic sports procedures. Patients were found to have low levels of pain, require minimal rescue opioids, and had no severe side effects related to the protocol. These results suggest a nonopioid alternative to pain management following common orthopedic sports procedures. LEVEL OF EVIDENCE Level IV, prospective case series.
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Affiliation(s)
- Vasilios Moutzouros
- Division of Sports Medicine, Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Toufic R Jildeh
- Division of Sports Medicine, Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Lafi S Khalil
- Division of Sports Medicine, Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Kaylin Schwartz
- Division of Sports Medicine, Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Laith Hasan
- Tulane University Medical School, New Orleans, Louisiana
| | - Robert N Matar
- University of Cincinnati Medical Center, 222 Piedmont Ave, Cincinnati, Ohio, U.S.A
| | - Kelechi R Okoroha
- Division of Sports Medicine, Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan.
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103
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Dattilo JR, Cororaton AD, Gargiulo JM, McDonald JF, Ho H, Hamilton WG. Narcotic Consumption in Opioid Naïve Patients Undergoing Unicompartmental and Total Knee Arthroplasty. J Arthroplasty 2020; 35:2022-2026. [PMID: 32265140 DOI: 10.1016/j.arth.2020.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/05/2020] [Accepted: 03/11/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is associated with increased risk of prolonged narcotic requirement compared to unicompartmental knee arthroplasty (UKA). The purpose of the current study is to compare acute postoperative narcotic consumption between the 2 procedures and quantify narcotic consumption. METHODS From October 2017 to August 2019 patients were surveyed for four weeks to determine the amount and duration of opioids consumed and requirement for continued narcotics. Among 976 opioid naïve patients, 314 (32%) underwent UKA and 662 (68%) underwent TKA. Patients were analyzed according to specific narcotic prescribed. Total morphine equivalent dose (MED), number of pills, duration, refill percentage, and usage percentage for 4 weeks were calculated for each procedure. RESULTS MED used in the postoperative period was lower in patients undergoing UKA than TKA (200 ± 195 vs 259 ± 250 MED, P = .002). Total number of pills consumed and duration of use was less in UKA compared to TKA regardless of which opioid was prescribed. A smaller proportion of patients required narcotics for 4 weeks after UKA (32% vs 43%, P < .001), and fewer UKA patients required narcotic refills (14% vs 27%, P < .001). Sixty pills of any 1 type of narcotic was sufficient for 90% of UKA patients and over 75% of TKA patients. CONCLUSION UKA is associated with less narcotic consumption, shorter duration of use, less refills, and lower likelihood of narcotic requirement for 4 weeks. We report narcotic consumption patterns for both procedures to aid surgeons in judicious postoperative prescribing. LEVEL OF EVIDENCE This is a level III retrospective cohort study reviewing narcotic use in over 900 consecutive opioid naïve patients undergoing UKA or TKA.
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Affiliation(s)
| | | | | | | | - Henry Ho
- Anderson Orthopaedic Research Institute, Alexandria, Virginia
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104
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Barnett S, Murray MM, Liu S, Micheli LJ. Resolution of Pain and Predictors of Postoperative Opioid use after Bridge-Enhanced Anterior Cruciate Ligament Repair and Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2020; 2:e219-e228. [PMID: 32548587 PMCID: PMC7283945 DOI: 10.1016/j.asmr.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/12/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose To compare postoperative pain scores and opioid use between patients undergoing a standard arthroscopic anterior cruciate ligament reconstruction (ACLR) using hamstring autograft with those undergoing a suture repair augmented with an extracellular matrix scaffold (bridge-enhanced ACL repair) performed through an arthrotomy and to determine factors predictive of postoperative opioid use and levels of overprescription. Methods A nonrandomized controlled trial was conducted with 20 patients (10 ACLR, 10 bridge-enhanced ACL repair), aged 18 to 35 years. All surgeries were performed by a single surgeon. A pain medication log was provided to patients on discharge. No regional anesthesia was performed. Pain scores via a visual analog pain scale were recorded at each visit. Correlations between preoperative and intraoperative characteristics and postoperative opioid use were determined. Results The total morphine-equivalent dose ranged from 30 to 309 mg (4-42 pills oxycodone) for the ACLR group and 75 to 254 mg (10-34 pills oxycodone) for the bridge-enhanced ACL repair group. The average opioid use per day was 35.8 mg for the patients undergoing bridge-enhanced ACL repair and 44.2 mg for patients undergoing ACLR (P = .29). Pain scores at time points up to 2 years postoperatively were not significantly different between the 2 groups. Across both groups, the average oversupply of oxycodone was 46 pills per patient, a greater than 70% unused opiate rate. Preoperative body mass index and preoperative Knee Injury and Osteoarthritis Outcome Scores pain score were predictive of greater postoperative opioid use per day, whereas age, concurrent meniscal repair, and operative time were not. Conclusions Total overall opiate intake was not different between the patients undergoing bridge-enhanced ACL repair through an arthrotomy and those undergoing arthroscopic ACLR. Both groups had similar pain scores from 2 weeks to 2 years postoperatively. Greater body mass index and greater preoperative pain (lower Knee Injury and Osteoarthritis Outcome Scores pain score) correlated with greater postoperative opioid use per day. There was an overprescription of opioids across all patients. Level of Evidence Level III, case control study (therapeutic).
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Affiliation(s)
- Samuel Barnett
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital Boston, Massachusetts, U.S.A
| | - Martha M Murray
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital Boston, Massachusetts, U.S.A
| | - Shanshan Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital Boston, Massachusetts, U.S.A
| | | | - Lyle J Micheli
- Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital Boston, Massachusetts, U.S.A
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105
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Vassão PG, Renno AC, Smith BN, Bennett GB, Murphy M, Liebert A, Chow R, Laakso EL. Pre-Conditioning and Post-Operative Photobiomodulation Therapy by a Novel Light Patch System for Knee Arthroplasty: A Protocol for a Phase 1 Study. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 38:206-214. [DOI: 10.1089/photob.2019.4751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Ana Claudia Renno
- Department of Biosciences, Federal University of São Paulo, Santos, Brazil
| | | | | | | | - Ann Liebert
- Sydney Adventist Hospital, Wahroonga, Australia
| | | | - E-Liisa Laakso
- Mater Research, South Brisbane, Australia
- Menzines Health Institute, Griffith University, Queensland, Australia
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106
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Pronk Y, Peters MCWM, Sheombar A, Brinkman JM. Effectiveness of a Mobile eHealth App in Guiding Patients in Pain Control and Opiate Use After Total Knee Replacement: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e16415. [PMID: 32167483 PMCID: PMC7101497 DOI: 10.2196/16415] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/10/2019] [Accepted: 12/21/2019] [Indexed: 12/16/2022] Open
Abstract
Background Little is known about pain and opiate use at home directly after total knee replacement (TKR). Due to adverse effects, low opiate use is desired. An electronic health app (PainCoach) was developed to guide patients in pain control and opiate use. Objective The aim of this paper was to investigate the effects of the PainCoach app on pain control and opiate use in patients who underwent TKR during the first 2 weeks at home after surgery. Methods In an unblinded randomized controlled trial, patients scheduled for TKR were offline recruited and randomized to a PainCoach group or control group. In the PainCoach group, the PainCoach app was downloaded on each patient’s smartphone or tablet. In response to the patient’s input of the pain experienced, the PainCoach app gave advice on pain medication use, exercises/rest, and when to call the clinic. This advice was the same as that received during usual care. The control group received usual care. The primary outcomes were opiate use and visual analog scale (VAS) pain scores at rest, during activity, and at night during the first 2 weeks at home after surgery, which were collected daily from day 1 until 14 postoperatively by online questionnaires. The actual amount of app use was recorded, and active use was defined as ≥12 total app uses. Results The pain scores did not differ between the groups. The PainCoach group (n=38) used 23.2% less opiates (95% CI −38.3 to −4.4; P=.02) and 14.6% more acetaminophen (95% CI 8.2-21.3; P<.001) when compared with the findings in the control group (n=33). The PainCoach app was used 12 (IQR 4.5-22.0) times per patient. In the active PainCoach subgroup (n=19), the following were noted when compared with the findings in the control group: 4.1 times faster reduction of the VAS pain score during activity (95% CI −7.5 to −0.8; P=.02), 6.3 times faster reduction of the VAS pain score at night (95% CI −10.1 to −2.6; P=.001), 44.3% less opiate use (95% CI −59.4 to −23.5; P<.001), 76.3% less gabapentin use (95% CI −86.0 to −59.8; P<.001), and 21.0% more acetaminophen use (95% CI 12.6-30.0; P<.001). Conclusions The use of the PainCoach app contributes to reduced opiate use in the initial period at home after TKR. Active use of this app leads to a further reduction in opiate use and improved pain control. Trial Registration ClinicalTrials.gov NCT03961152; https://clinicaltrials.gov/ct2/show/NCT03961152
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Affiliation(s)
- Yvette Pronk
- Research Department, Kliniek ViaSana, Mill, Netherlands
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107
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Ma HH, Chou TFA, Tsai SW, Chen CF, Wu PK, Chen WM. The efficacy of continuous versus single-injection femoral nerve block in Total knee Arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord 2020; 21:121. [PMID: 32093655 PMCID: PMC7041113 DOI: 10.1186/s12891-020-3148-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/19/2020] [Indexed: 12/21/2022] Open
Abstract
Background Continuous femoral nerve block (cFNB) has been developed to extend the analgesic effect since the efficacy of single-injection femoral nerve block (sFNB) is often limited to approximately 16–24 h. The aim of this meta-analysis was to validate the add-on effect of cFNB in the setting of a multimodal analgesic protocol. Methods We performed a comprehensive literature review on Web of Science, Embase, the Cochrane Library and PubMed. Eight randomized controlled trials (N = 626) that compared the efficacy of cFNB with sFNB were included. The primary outcome domains consist of visual analog scale (VAS) score at postoperative 24 and 48 h. The secondary outcome domains include opioid consumption, length of hospital stay and incidence of nausea. Results Our analysis revealed that cFNB was associated with a lower VAS score at 24 h (SMD: -0.277;95% CI − 0.503 to − 0.05). However, the difference of VAS score did not meet the minimal clinically importance difference for total knee arthroplasty (TKA). VAS score at 48 h was similar between the cFNB and sFNB group. The cFNB group was associated with less amount of opioids consumed at both 24(SMD: -1.056;95% CI − 1.737 to − 0.375) and 48 h(SMD: -1.040;95% CI − 1.790 to − 0.289). Length of hospital stay and incidence of nausea were similar between the two groups. Conclusion In the setting of a multimodal analgesic protocol, patients might benefit from cFNB with regards to a reduced need of opioids in the early postoperative period. However, we did not find a clinically significant difference in pain scores at different time points between the cFNB and sFNB group. Level of evidence I; meta-analysis.
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Affiliation(s)
- Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Te-Feng Arthur Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan. .,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec 2, Shi-Pai Road, Taipei, 112, Taiwan.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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108
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Orfield NJ, Gaddis A, Russell KB, Hartman DW, Apel PJ, Mierisch C. New Long-Term Opioid Prescription-Filling Behavior Arising in the 15 Months After Orthopaedic Surgery. J Bone Joint Surg Am 2020; 102:332-339. [PMID: 31851029 DOI: 10.2106/jbjs.19.00241] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The opioid crisis is a well-known public health issue. The risk of new long-term opioid prescription-filling behavior has been investigated after certain spinal procedures and total knee and hip arthroplasty. However, this has not been examined after many other common orthopaedic procedures. The purpose of this study was to determine the rates of long-term opioid prescription-filling behavior after common orthopaedic surgical procedures in patients who were not taking opioids preoperatively. METHODS This study utilized the Virginia All-Payer Claims Database (APCD), an insurance claims database with data from 3.7 to 4 million patients per year. Patients who underwent orthopaedic procedures and who had not filled an opioid prescription in the time period from 2 weeks to 1 year preceding the surgical procedure were selected for evaluation in our study. The percentage of these patients who then filled at least 10 prescriptions or a 120-day supply of opioids in the time period from 90 to 455 days following the surgical procedure was calculated for the 50 most commonly billed orthopaedic surgical procedures. RESULTS The rate of long-term opioid prescription-filling behavior in patients who were not taking opioids preoperatively for the 50 most common orthopaedic procedures was 5.3% (95% confidence interval, 5.1% to 5.5%). The highest rates were observed after spinal procedures. The lowest rates were seen after anterior cruciate ligament (ACL) reconstruction. Revision surgical procedures were found to have a significantly higher rate than primary procedures (p < 0.05). The rate was also related to increasing case complexity. CONCLUSIONS New long-term opioid prescription-filling behavior is common after orthopaedic surgical procedures in patients who were not taking opioids preoperatively. Risk factors include spine surgery, revision surgery, and cases with increased complexity. Orthopaedic surgeons need to be aware of this risk. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Noah J Orfield
- Departments of Orthopaedic Surgery (N.J.O., P.J.A., and C.M.) and Psychiatry (D.W.H.), Carilion Clinic, Roanoke, Virginia
| | - Andrew Gaddis
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | | | - David W Hartman
- Departments of Orthopaedic Surgery (N.J.O., P.J.A., and C.M.) and Psychiatry (D.W.H.), Carilion Clinic, Roanoke, Virginia
| | - Peter J Apel
- Departments of Orthopaedic Surgery (N.J.O., P.J.A., and C.M.) and Psychiatry (D.W.H.), Carilion Clinic, Roanoke, Virginia.,Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Cassandra Mierisch
- Departments of Orthopaedic Surgery (N.J.O., P.J.A., and C.M.) and Psychiatry (D.W.H.), Carilion Clinic, Roanoke, Virginia.,Virginia Tech Carilion School of Medicine, Roanoke, Virginia
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109
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Standardized Opioid Prescription Protocol Reduces Opioid Consumption After Total Joint Arthroplasty. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:JAAOSGlobal-D-19-00163. [PMID: 32072125 PMCID: PMC7004495 DOI: 10.5435/jaaosglobal-d-19-00163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Previous studies demonstrate routine overprescription of pain medications after total joint arthroplasty (TJA). A standardized reduced opioid prescription protocol for TJA was initiated at our institution, which we hypothesized would lead to a reduction in opioid consumption compared with patients who had surgery before initiation of the new protocol. Methods We evaluated 97 consecutive opioid-naive patients undergoing primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) using a standardized opioid prescription protocol (standardized group). A control subject group consisted of 99 patients undergoing TKA and THA just before the adaptation of the standardized prescribing protocol (historic group). Postoperatively, patients brought their remaining pain medication to their 1-month follow-up visit. The number of pills consumed was counted and converted into oral morphine equivalents (OME). Current pain level and the need for pain medication refill was assessed. Results Among TKA patients, mean opioid consumption in the standardized group (48.5 pills; 432 OME) was markedly less than the historic group (76.2 pills; 903 OME) (both P < 0.01). Refills were required in 50% of the standardized group and 29% of the historic group (P = 0.038). Average pain scores for the standardized and historic groups were 2.3 and 3.2, respectively (P = 0.057). Among THA patients, mean opioid consumption in the standardized group (19.1 pills; 200 OME) was markedly less than the historic group (41.3 pills; 504 OME) (both P < 0.01). Refills were required in 16% of the standardized group and 8% of the historic group (P = 0.263). Average pain scores for the standardized and historic groups were 1.7 and 1.8, respectively (P = 0.608). Discussion Initiation of a standardized opioid prescribing protocol after TJA for opioid-naive patients led to a reduction in opioid consumption, but resulted in an increased need for refills.
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110
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Successful Implementation of an Accelerated Recovery and Outpatient Total Joint Arthroplasty Program at a County Hospital. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:e110. [PMID: 31773082 PMCID: PMC6860134 DOI: 10.5435/jaaosglobal-d-19-00110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Outpatient and accelerated recovery total joint arthroplasty (TJA) programs have become standard for private and academic practices. County hospitals traditionally serve patients with limited access to TJA and psychosocial factors which create challenges for accelerated recovery. The effectiveness of such programs at a county hospital has not been reported. Methods In 2017, our county hospital implemented an accelerated recovery protocol for all TJA patients. This protocol consisted of standardized, preoperative medical and psychosocial optimization, perioperative spinal anesthesia, tranexamic acid and local infiltration analgesia use, postoperative emphasis on non-narcotic analgesia, and early mobilization. LOS, complications, disposition, and cost were compared between patients treated before and after protocol implementation. Results In 15 months, 108 primary TJA patients were treated. Compared with the previous 108 TJA patients, LOS dropped from 3.4 to 1.6 days (P < 0.001), more patients discharged home (92% versus 72%, P < 0.001), average hospitalization and procedure-specific costs decreased 24.7% and 22.1%, respectively, and were significantly fewer complications (7% versus 21%, P = 0.007). Conclusions Implementation of an accelerated recovery TJA program at a County Hospital is novel. This implementation requires careful patient selection and a coordinated multidisciplinary approach and is a safe and cost-effective method of delivering high-quality care to an underserved cohort.
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111
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Singh JA, Lemay CA, Nobel L, Yang W, Weissman N, Saag KG, Allison J, Franklin PD. Association of Early Postoperative Pain Trajectories With Longer-term Pain Outcome After Primary Total Knee Arthroplasty. JAMA Netw Open 2019; 2:e1915105. [PMID: 31722026 PMCID: PMC6902788 DOI: 10.1001/jamanetworkopen.2019.15105] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Studies to date have not comprehensively examined pain experience after total knee arthroplasty (TKA). Discrete patterns of pain in this period might be associated with pain outcomes at 6 to 12 months after TKA. OBJECTIVES To examine patterns of individual post-TKA pain trajectories and to assess their independent associations with longer-term pain outcome after TKA. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study combined data from a national US TKA cohort with ancillary pain severity data at 2 weeks and 8 weeks after the index TKA using a numeric rating scale. All participants received primary, unilateral TKA within the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) national network of community sites in 22 states or at the lead site (University of Massachusetts Medical School). Participants had a date of surgery between May 1, 2013, and December 1, 2014. The data analysis was performed between January 13, 2015, and July 5, 2016. EXPOSURES Pain trajectories in the postoperative period (8 weeks). MAIN OUTCOMES AND MEASURES Index knee pain at 6 months after TKA using the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain scale. Group-based trajectory methods examined the presence of pain trajectories in the postoperative period (8 weeks) and assessed whether trajectories were independently associated with longer-term pain (6 months). RESULTS The cohort included 659 patients who underwent primary TKA with complete data at 4 points (preoperative, 2 weeks, 8 weeks, and 26 weeks). Their mean (SD) age was 67.1 (8.0) years, 64.5% (425 of 659) were female, the mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 30.77 (5.66), 94.5% (613 of 649) were white, and the mean (SD) preoperative 36-Item Short Form Health Survey physical component summary and mental component summary scores were 34.1 (8.2) and 53.8 (11.4), respectively. Two pain trajectory subgroups were identified at 8 weeks after TKA: patients who experienced fast pain relief in the first 8 weeks after TKA (fast pain responders, composing 72.4% [477 of 659] of the sample) and patients who did not (slow pain responders, composing 27.6% [182 of 659] of the sample). After adjusting for patient factors, the pain trajectory at 8 weeks after TKA was independently associated with the mean KOOS pain score at 6 months, with a between-trajectory difference of -11.3 (95% CI, -13.9 to -8.7). CONCLUSIONS AND RELEVANCE The trajectory among slow pain responders at 8 weeks after surgery was independently associated with improved but greater persistent index knee pain at 6 months after TKA compared with that among fast pain responders. Early identification of patients with a trajectory of slow pain response at 8 weeks after TKA may offer an opportunity for interventions in the perioperative period to potentially improve the long-term pain outcomes after TKA.
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Affiliation(s)
- Jasvinder A. Singh
- Medicine Service, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
- Department of Medicine, The University of Alabama at Birmingham
- Division of Epidemiology, School of Public Health, The University of Alabama at Birmingham
| | - Celeste A. Lemay
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester
| | - Lisa Nobel
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Wenyun Yang
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester
| | - Norman Weissman
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Kenneth G. Saag
- Department of Medicine, The University of Alabama at Birmingham
- Division of Epidemiology, School of Public Health, The University of Alabama at Birmingham
| | - Jeroan Allison
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Patricia D. Franklin
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester
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Kazmers NH, Stephens AR, Tyser AR. Effects of Baseline Opioid Medication Use on Patient-Reported Functional and Psychological Impairment Among Hand Clinic Patients. J Hand Surg Am 2019; 44:829-839. [PMID: 31477406 DOI: 10.1016/j.jhsa.2019.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/22/2019] [Accepted: 07/12/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To test the null hypothesis that baseline opioid use is not associated with functional or psychological impairment among new hand surgery clinic patients, as measured by Patient-Reported Outcomes Measurement Information System (PROMIS) instruments. METHODS New adult (≥ 18 years) patient visits to a tertiary academic orthopedic nonshoulder hand and upper extremity clinic between February 2014 and April 2018 were eligible. Collected outcomes include the question, "Are you currently taking narcotic pain medications?", the PROMIS Upper Extremity (UE) computerized adaptive testing (CAT), abbreviated version of the Disorders of the Arm, Shoulder, and Hand (QuickDASH), PROMIS Physical Function (PF) CAT, PROMIS Pain Interference (PI) CAT, PROMIS Depression CAT, and PROMIS Anxiety CAT. Patients responding to the opioid question, plus the UE CAT or QuickDASH, were included. Bivariate and multivariable logistic regression modelling were used to assess factors associated with baseline scores. RESULTS Of 5997 included patients, 1,046 (17.4%) reported baseline opioid use. Patients in the opioid group demonstrated significantly worse scores on all patient-reported outcomes, and a significantly greater proportion of patients with PROMIS Depression CAT scores exceeding 60 (associated with a clinical diagnosis of depression; 29.5% vs 15.5%). Lower functional scores were observed in the opioid group after controlling for age, sex, other activity-limiting comorbidities, and either depression (UE CAT -7.0; QuickDASH +18.1; and PF CAT -6.6 points), anxiety (UE CAT -6.3; QuickDASH +16.4; PF CAT -6.3), or PI (UE CAT -3.7; QuickDASH +9.5; and PF CAT -4.2 points). Pain interference was greater among opiate users when controlling for age, sex, other activity-limiting comorbidities, and baseline function or psychological status: PI was 2.5, 5.0, or 4.3 points greater when controlling for the PROMIS UE CAT, Depression CAT, or Anxiety CAT. CONCLUSIONS New patients presenting to a hand surgery clinic who endorse use of opioid medications at baseline report significantly decreased physical function, increased psychological burden, and greater levels of pain interference than nonusers. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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113
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A Goal-directed Quality Improvement Initiative to Reduce Opioid Prescriptions After Orthopaedic Procedures. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:e109. [PMID: 31773081 PMCID: PMC6860138 DOI: 10.5435/jaaosglobal-d-19-00109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Orthopaedic surgeons are increasingly aware of deleterious effects of the opioid epidemic and the association between overprescription and diversion toward nonmedical opioid use or substance abuse. Opiate prescriptions at the time of hospital discharge have been identified as target for intervention. This study describes the successful outcome of a goal-directed intervention aimed at decreasing opioid overprescription by providing routine feedback to providers regarding their prescribing patterns.
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114
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115
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Yayac M, Li WT, Ong AC, Courtney PM, Saxena A. The Efficacy of Liposomal Bupivacaine Over Traditional Local Anesthetics in Periarticular Infiltration and Regional Anesthesia During Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2019; 34:2166-2183. [PMID: 31178385 DOI: 10.1016/j.arth.2019.04.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 03/30/2019] [Accepted: 04/23/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Since its Food and Drug Administration approval in 2011 as a local anesthetic for postsurgical analgesia, liposomal bupivacaine (LB) has been incorporated into the periarticular injection (PAI) of many knee surgeons. The slow release of this medication from vesicles should significantly extend the duration of its analgesic effect, but current evidence has not clearly demonstrated this benefit. METHODS We systematically searched electronic databases including PubMed, MEDLINE, Cochrane Library, EMBASE, ScienceDirect, and Scopus, as well as the Journal of Arthroplasty web page for relevant articles. All calculations were made using Review Manager 5.3. RESULTS We identified 42 studies that compared LB to an alternate analgesic modality. Seventeen of these studies were controlled trials that were included in meta-analysis. Significant differences were seen in pain scores with LB over a peripheral nerve block (mean difference = 0.45, P = .02) and LB over a traditional PAI (standard mean difference = -0.08, P = .004). CONCLUSION While LB may offer a statistically significant benefit over a traditional PAI, the increase in pain control may not be clinically significant and it does not appear to offer a benefit in reducing opioid consumption. However, there is no standardization among current studies, as they vary greatly in design, infiltration technique, and outcome measurement, which precludes any reliable summarization of their results. Future independent studies using a standardized protocol are needed to provide clear unbiased evidence.
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Affiliation(s)
- Michael Yayac
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - William T Li
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | - Alvin C Ong
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA
| | | | - Arjun Saxena
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA
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Premkumar A, Lovecchio FC, Stepan JG, Sculco PK, Jerabek SA, Gonzalez Della Valle A, Mayman DJ, Pearle AD, Alexiades MM, Albert TJ, Cross MB, Haas SB. Characterization of opioid consumption and disposal patterns after total knee arthroplasty. Bone Joint J 2019; 101-B:98-103. [DOI: 10.1302/0301-620x.101b7.bjj-2018-1518.r1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Aims The aim of this study was to determine the general postoperative opioid consumption and rate of appropriate disposal of excess opioid prescriptions in patients undergoing primary unilateral total knee arthroplasty (TKA). Patients and Methods In total, 112 patients undergoing surgery with one of eight arthroplasty surgeons at a single specialty hospital were prospectively enrolled. Three patients were excluded for undergoing secondary procedures within six weeks. Daily pain levels and opioid consumption, quantity, and disposal patterns for leftover medications were collected for six weeks following surgery using a text-messaging platform. Results Overall, 103 of 109 patients (94.5%) completed the daily short message service (SMS) surveys. The mean oral morphine equivalents (OME) consumed during the six weeks post-surgery were 639.6 mg (sd 323.7; 20 to 1616) corresponding to 85.3 tablets of 5 mg oxycodone per patient. A total of 66 patients (64.1%) had stopped taking opioids within six weeks of surgery and had the mean equivalent of 18 oxycodone 5 mg tablets remaining. Only 17 patients (25.7%) appropriately disposed of leftover medications. Conclusion These prospectively collected data provide a benchmark for general opioid consumption after uncomplicated primary unilateral TKA. Many patients are prescribed more opioids than they require, and leftover medication is infrequently disposed of appropriately, which increases the risk for illicit diversion. Cite this article: Bone Joint J 2019;101-B(7 Supple C):98–103
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Affiliation(s)
- A. Premkumar
- Hospital for Special Surgery, New York, New York, USA
| | | | - J. G. Stepan
- Hospital for Special Surgery, New York, New York, USA
| | - P. K. Sculco
- Hospital for Special Surgery, New York, New York, USA
| | - S. A. Jerabek
- Hospital for Special Surgery, New York, New York, USA
| | | | - D. J. Mayman
- Hospital for Special Surgery, New York, New York, USA
| | - A. D. Pearle
- Hospital for Special Surgery, New York, New York, USA
| | | | - T. J. Albert
- Hospital for Special Surgery, New York, New York, USA
| | - M. B. Cross
- Hospital for Special Surgery, New York, New York, USA
| | - S. B. Haas
- Hospital for Special Surgery, New York, New York, USA
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Daniels SD, Garvey KD, Collins JE, Matzkin EG. Patient Satisfaction With Nonopioid Pain Management Following Arthroscopic Partial Meniscectomy and/or Chondroplasty. Arthroscopy 2019; 35:1641-1647. [PMID: 31072715 DOI: 10.1016/j.arthro.2019.03.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the efficacy of nonopioid pain medication related to patient satisfaction with postoperative pain and identify potential risk factors for decreased patient satisfaction with nonopioid pain medications. METHODS This was a prospective study conducted between January 2017 and April 2018 at a single institution. A power analysis was performed a priori, which determined an appropriate cohort size of 163 patients. Inclusion criteria were all patients older than age 18 who were undergoing a knee arthroscopy for a partial meniscectomy and/or chondroplasty. Patients were prescribed maximum-strength ibuprofen or acetaminophen and completed a preoperative and 2-week postoperative questionnaire to assess satisfaction with pain management. RESULTS Among the 163 patients enrolled in the study, the average age was 48.7 years (range 21-73 years); 74 (45%) were male and 89 (55%) were female. Overall, 81.6% (95% confidence interval 75.7% to 87.5%, P < .001) of patients reported satisfactory postoperative pain control without the use of opioids. Patients with a history of opioid use were found to be less likely to report adequate satisfaction with pain control than were patients who had no prior history of opioid use (relative risk 0.65, 95% confidence interval 0.38-1.12, P = .031). CONCLUSIONS Based on the findings of this study, 82% of patients who undergo arthroscopic partial meniscectomy and/or chondroplasty can achieve satisfactory pain control with nonopioid pain management. LEVEL OF EVIDENCE Prospective comparative study: Level II.
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Affiliation(s)
- Stephen D Daniels
- Larner College of Medicine, University of Vermont, Burlington, Vermont, U.S.A
| | - Kirsten D Garvey
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - Jamie E Collins
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A
| | - Elizabeth G Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, U.S.A..
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118
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Johnson QL, Patel PP. Opioid Use and the Perioperative Patient. AORN J 2019; 109:635-642. [PMID: 31025354 DOI: 10.1002/aorn.12688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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119
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Walega D, McCormick Z, Manning D, Avram M. Radiofrequency ablation of genicular nerves prior to total knee replacement has no effect on postoperative pain outcomes: a prospective randomized sham-controlled trial with 6-month follow-up. Reg Anesth Pain Med 2019; 44:rapm-2018-100094. [PMID: 31023931 DOI: 10.1136/rapm-2018-100094] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/15/2019] [Accepted: 02/20/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Refractory chronic knee pain from osteoarthritis (OA) is commonly treated with total knee arthroplasty (TKA). TKA can be associated with severe postoperative pain and persistent postsurgical knee pain. Poorly controlled postoperative pain can negatively effect functional outcomes following TKA, and effective opioid-sparing analgesia is key to the ideal recovery. Genicular nerve radiofrequency ablation (GN-RFA) has been shown in several trials to be clinically effective in patients with severe refractory knee pain from OA. We aimed to assess if preoperative GN-RFA would improve postoperative pain outcomes following TKA. METHODS This was a sham-control prospective clinical trial in which blinded participants were randomized to image-guided GN-RFA or a simulated sham procedure 2-6 weeks prior to elective TKA. Outcomes were assessed at 48 hours and 1, 3 and 6 months following TKA. RESULTS Seventy participants enrolled in this study. As compared with sham controls, GN-RFA had no treatment effect on postoperative opioid consumption, pain or functional measures at any time point. CONCLUSIONS Cooled RFA of the superior lateral, superior medial and inferomedial genicular nerves, when performed 2-6 weeks prior to elective TKA as part of a multimodal postoperative pain management regime, had no measurable effect on postoperative opioid use, analgesia use or function in the 48 hours following surgery. In addition, we found no longer term effect on outcome measures 1, 3 and 6 months after TKA. TRIAL REGISTRATION NUMBER NCT02746874.
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Affiliation(s)
- David Walega
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Zachary McCormick
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah, USA
| | - David Manning
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Avram
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Goode VM, Morgan B, Muckler VC, Cary MP, Zdeb CE, Zychowicz M. Multimodal Pain Management for Major Joint Replacement Surgery. Orthop Nurs 2019; 38:150-156. [PMID: 30768538 PMCID: PMC6727971 DOI: 10.1097/nor.0000000000000525] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Effective pain management for orthopaedic major joint replacement is key to achieving earlier recovery, better functioning, and high rates of patient satisfaction. In an effort to decrease opioid dependency, practitioners are turning to multimodal pain management, which involves the use of multiple analgesic agents and techniques. To utilize this technique, a patient's history of and preoperative consumption of medications to treat pain impacts the success of this regimen. Multimodal pain management involves the use of nonsteroidal anti-inflammatory drugs, acetaminophen, N-methyl-D-aspartate antagonists, gabapentin, serotonin inhibitors, regional techniques, and opioids as needed. It is necessary for the nurse to understand the mechanism of pain and how the multimodal adjuncts target the pain response to benefit the patient's perioperative course as well as his or her postoperative and discharge management.
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Affiliation(s)
- Victoria M Goode
- Victoria M. Goode, PhD, CRNA, Duke University School of Nursing, Durham, NC. Brett Morgan, DNP, CRNA, Duke University School of Nursing, Durham, NC. Virginia C. Muckler, DNP, CRNA, CHSE, Duke University School of Nursing, Durham, NC. Michael P. Cary, Jr., PhD, RN, Duke University School of Nursing, Durham, NC. Christine E. Zdeb, BSN, RN, ONC, Duke University School of Nursing, Durham, NC. Michael Zychowicz, DNP, ANP, ONP, FAAN, FAANP, Duke University School of Nursing, Durham, NC
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Karahan M. Editorial Commentary: Unraveling Gordian's Knot: Opioids in Arthroscopy Pain Management. Arthroscopy 2018; 34:3244-3245. [PMID: 30509434 DOI: 10.1016/j.arthro.2018.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 02/02/2023]
Abstract
Pain management is crucial for a successful result after various knee surgeries. Opioids may be included in the postoperative pain management protocol but may be abused if not controlled. Following knee arthroscopy and related surgery, adolescent and young adult patients are commonly overprescribed opioids. The driving force behind opioid prescription should be explored in addition to reviewing and emphasizing perioperative interventions that can reduce postoperative opioid consumption, including wound injections and peripheral nerve blocks.
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Jiranek WA. Introduction: How Should the Joint Surgeon Respond to the Opioid Crisis? J Arthroplasty 2018; 33:3371. [PMID: 30177301 DOI: 10.1016/j.arth.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 02/01/2023] Open
Affiliation(s)
- William A Jiranek
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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